The inspection took place on 12 June 2018 and was unannounced.

Gardens Neurological Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. They are registered to provide accommodation and treatment for up to 54 people, aged 18 years or older, with complex long term neurological conditions, brain or spinal injuries.

Gardens Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. The centre provides nursing care, personal care, medical treatment and diagnostic procedures in a purpose-built environment over two floors. The staff at the centre assists people’s recovery wherever possible and specialise in slow stream rehabilitation. Some people had lived there for many years and others were more recent admissions working towards returning to their own homes. There were 51 people accommodated at the home at the time of this inspection.

At our last inspection 24 May 2017 we found that the provider did not take appropriate actions to ensure that people’s safety and welfare was promoted and protected and they were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We also found that the providers quality assurance systems had not identified potential risks to people's safety and wellbeing and they were in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. We rated the service Requires Improvement.

At this inspection, we found that sufficient improvements were made to support the rating of Good. Following the inspection on 24 May 2017 the provider submitted an action plan to us to detail how they were going to address the concerns we found. We found that they have completed the actions they told us they were going to do.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood their responsibilities in relation to safeguarding. Training and systems in place supported this. While records had some gaps, staff knew how to support people safely in line with their individual assessed risks. Observations demonstrated that there were enough staff available to meet people's needs safely and well. Staff confirmed their competency in medicines was routinely assessed to ensure safe practice. No concerns in relation to prevention and control of infection were identified. Staff confirmed their understanding of their responsibility in reporting and recording accidents and incidents. We saw that lessons were learned after incidents and additional control measures were discussed to minimise the risk of reoccurrence.

People's needs were assessed and information about their diverse needs was recorded. People were supported by staff who were provided with opportunities for training, skills development and ongoing assessment of their competence. People had choices in relation to food and drink and were encouraged to have good nutrition and fluid intake. People’s specific dietary needs in relation to their culture and lifestyle preferences were recognised and provided for. People were involved in decisions regarding the environment of their personal space. The premises offered some challenges in terms of space and decor was tired in places. Staff had received training in and understood the impact of Mental Capacity Act 2005 and Deprivation of Liberty Safeguards for people living in the service. Observation showed that staff sought people'

The inspection took place on 13 June 2017 and was unannounced.

Gardens Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. It is registered to provide accommodation and care for up to 54 adults with a physical disability and older people. The care provided includes nursing care, personal care, medical treatment and diagnostic procedures. There were 51 people accommodated at the home at the time of this inspection.

The people who used the service had complex needs and were totally dependent on staff support in all aspects of their life. Some people used equipment to help them breathe due to their physical disability. Many people were unable to communicate verbally and relied on staff abilities and skills to read their body language if they were in pain or discomfort.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection of this service in August 2015 the service was rated Good. At this inspection we identified some potential for risk to people’s safety and found that staff did not always interact with people and did not always promote and respect people’s dignity. Record keeping did not always accurately reflect the care and support provided. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service. However, this process was not always effective as it had not identified issues we found during the course of this inspection.

People felt safe living at Gardens Neurological Centre. Staff understood how to keep people safe and risks to people's personal safety and well-being were identified and managed. The home was calm and people's needs were met by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements in place to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management team and were satisfied that they would be listened to.

The inspection took place on 06 August 2015 and was unannounced.

Gardens Neurological Centre is owned and operated by Ramsay Health Care UK Operations Limited, which is a subsidiary of Ramsay Health Care (UK) Limited. It provides accommodation and care for up to 54 adults with a physical disability and older people. The care provided includes nursing care, personal care, medical treatment and diagnostic procedures. There were 52 people accommodated at the home at the time of this inspection.

We last inspected the service on 11 November 2013 and found the service was meeting the required standards at that time.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to 15 people who lived at Gardens Neurological Centre.

People felt safe living at the Gardens Neurological Centre. Staff knew how to keep people safe and risks to people’s safety and well-being were identified and managed. The home was calm and people’s needs were met in a timely manner. The manager operated robust recruitment processes which helped to ensure that staff members employed to support people were fit to do so. There were suitable arrangements for the safe storage, management and disposal of people’s medicines.

Staff had the skills and knowledge necessary to provide people with safe and effective care and support. Staff received supervision from the management team which made them feel supported and valued. People were encouraged and enabled to make their own decisions as much as possible. People received the assistance they needed to eat and drink sufficient quantities. People’s health needs were well catered and appropriate referrals were made to health professionals when needed.

All people we spoke with were complimentary about the care and kindness demonstrated by the staff team. Staff members were knowledgeable about individuals’ needs and preferences and people were involved in the planning of their care where they were able. Visitors were encouraged at any time of the day and people’s privacy was respected and promoted.

There were arrangements for a range of activities and stimulation in the home. There were systems in place to facilitate feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and satisfied that they would be listened to.

There was an effective management structure in place that meant that relatives and staff were able to speak with a member of the senior management team if they had a concern. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We spoke with two people who lived at the centre. One person told us, "I’m well treated…I would not have anything done differently…I’m staying here now and I’m happy with that idea."

We saw that the care records contained an initial risk assessment and care management plan (RAMP) which covered all aspects of the person's needs. There were also risk assessment and management plans (RAMPs) for areas such as respiratory needs, physical health, personal hygiene, elimination, communication and tissue viability. In one record we found some discrepancies between the date of some of the RAMP evaluations and the date of their last review.

When we carried out an inspection of Gardens Neurological Centre on 24 June 2013 we found that the level of cleanliness in some areas of the home was not of an appropriate standard. During our inspection on 11 November 2013 we found that these standards were met in all of the areas of the centre we looked at.

We found that there were sufficient staff to provide care for the people who lived at the centre at all times, including during the night time and also for those who required one-to-one care.

People told us that they or their relative had agreed to the care and treatment that they received. We spoke with two staff members. They told us that before giving any care they explained to the person what they were going to do and asked if it was alright with them.

People told us that they were happy with the care that they or their relative received. One relative told us, "The treatment is excellent." We looked at the care plans of five people who lived at the home. We found that these were personalised and detailed. Each contained a section headed 'All about me' which had been completed by the person or a relative on their behalf and an initial risk assessment and care management plan (RAMP) which covered all aspects of the person's needs.

People's opinions about the food provided varied widely and a relative told us it was normally cold. On the day of our inspection we found that the food provided at lunchtime was served at an acceptable temperature. We observed staff members as they assisted people to eat their food in a caring, respectful way.

We identified areas where cleanliness in the home was not of a satisfactory standard. For example, we saw cobwebs with small dead flies in the corners of windowsills in a bathroom and in the dining room.

Care plans that we looked at, together with all relevant assessments of risk, had been completed and reviewed on a monthly basis. People's records were kept securely in the nurse's office on each unit of the home.

The home was generally clean and bright, if a little cluttered. The people who lived at the home that we spoke with told us that staff treated them with dignity and respect. They told us that they were given choice in all areas and that they could, "Do exactly as I want to do." A representative of the people who lived at the home was on the Health and Safety Committee and also on the Infection Control Committee.

We were told that staff treated the people who lived at the home, "Very well." One person told us that they saw, "So much kindness" demonstrated by the staff.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began work.

We saw that personal records could not be accessed by unauthorised people and could be located promptly when needed. However the records were not always complete and up to date and were not therefore always accurate and fit for purpose.

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Most of the people who we spoke with when we visited the home on 19 January 2012 told us that they were treated with respect and that they were able to make decisions about the care that they received. Some visiting relatives of people living at The Gardens told us that they found that staff were very responsive and worked well with them to meet the needs respect the choices of people living at the home.

One relative said, “They are always doing something; staff are always helpful and responsive. We have never had any problems but I am confident they would take any concerns seriously and they would be acted upon.” Another relative told us, “Our relative’s wellbeing has improved no end since being at The Gardens.”

However several people told us that the activity provision was not as good as it had been previously. One person told us, “They used to do activities, they don’t do much now, maybe the odd crossword.” Another person said “There are no meaningful activities to provide mental stimulation, mindless sing a longs and pat dogs are not appropriate for everyone.”